Physicians have always been concerned with psychiatric patients who find the "sick role" comfortable and difficult to give up. In the past whether a patient remained sick or returned to normal was usually explained in terms of patient's sickness, his personality or the treatment he received. These factors, however, have never been strong enough to predict empirically which patients remain in the sick role. Recently it has become clearer that the patient's family and the treatment people he sees may have a part in such effects. The sociological theory of deviance called "labeling" theory alerts us to the question asked in this research: what part does the family and, especially, the treatment system have in sustaining the sick role? We will investigate sick role maintenance at two levels. First, we predict that the more "bureaucratic" the psychiatric treatment system (i.e., the more integrated, extensive and available the system to patients) the more likely that patients are maintained in the sick role. We will follow discharged first-admission psychiatric patients from a highly bureaucratic and a non-bureaucratic treatment system for one year after discharge to measure clinical symptoms and social performance at outcome. Second, we predict that, depending upon relative power and beliefs about illness certain patient/treatment agent (and patient/family) negotiations serve to discourage the patient from taking the normal role. We will measure the process of sick role maintenance by following a sub-sample of discharged patients through the first year, interviewing treatment people, patients and family at several points in time, using a panel design. The goal of the research, therefore, is to obtain an empirical causal model that shows how the patient's social experiences with family and treatment agents maintain some patients in the sick role.